Journal of neurosurgery
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Journal of neurosurgery · Nov 2023
Immunohistochemical markers predicting recurrence following resection and radiotherapy in chordoma patients: insights from a multicenter study.
Chordomas are rare tumors that often recur regardless of surgery with negative margins and postoperative radiotherapy. The predictive accuracy of widely used immunohistochemical (IHC) markers in addressing the recurrence of skull base chordomas (SBCs) is yet to be determined. This study aimed to investigate IHC markers in the prediction of recurrence after SBC resection with adjuvant radiation therapy. ⋯ The authors' machine learning algorithm identified pan-cytokeratin as the largest contributor to recurrence among other IHC markers after SBC resection. Machine learning may facilitate the prediction of outcomes in rare tumors, such as chordomas.
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Journal of neurosurgery · Nov 2023
Trends in successfully matched neurosurgery residency applicants.
The United States Medical Licensing Examination (USMLE) Step 1 recently transitioned to a pass/fail outcome, renewing interest in how programs select neurosurgical residents. This study investigates the association between match status and key academic metrics over time. ⋯ From 2009 to 2022, neurosurgical residency applicants grew in their achievements across many metrics. In the advent of Step 1 becoming pass/fail, this study suggests that Step 2 is not viewed by programs as an adequate replacement. However, the Step 1 grading transition may serve as an opportunity for other factors to be considered that may better predict success in neurosurgical residency.
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Journal of neurosurgery · Nov 2023
ReviewClinical trial implementation: a primer for neurosurgeons.
In the current landscape of evidence-based medicine, prospective clinical trials are an important avenue through which to establish the efficacy and safety of biomedical treatments compared with standard-of-care interventions. Depending on their scope and aims, clinical trials can be extremely costly and time intensive, and significant coordination is needed to ensure optimal utilization of healthcare resources, adherence to the principles of biomedical ethics, and appropriate interpretation of study results. This review highlights the core principles for designing and implementing clinical trials within neurosurgery, with the aim to provide clinicians with a framework for implementing both investigator-initiated and industry-sponsored trials.
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Journal of neurosurgery · Nov 2023
Multicenter StudySafety of discontinuing antiplatelet therapy 12-24 months after stent-assisted coil embolization: a multicenter retrospective study.
Antiplatelet medication is required after stent-assisted coil embolization (SACE) to avoid thromboembolic complications. Currently, there is no consensus on how long the antiplatelet agent should be maintained. The authors investigated clinical outcomes in patients who discontinued their antiplatelet agent 12-24 months after SACE. ⋯ These results suggest that it may be safe to discontinue antiplatelet medication after SACE in patients at low risk for ischemia, and that it appears safe to discontinue the agent at approximately 15 months after the procedure. Large cohort-based prospective studies or randomized clinical trials are warranted to confirm these results.